Ask HN: Why don’t we have mobile vaccination vans for the USA?

The logistics of mobile distribution of a fast expiring product are much more complex than you think, and spoilage and expiration losses need to be acceptable at some level to proceed. I think in the case of the vaccine, the latter is well understood, but no one wants to be responsible or held accountable for any vaccines expiring, due to the optics of the situation.

I worked on Uber briefly while we tested the early version of UberEats which involved distributing burritos in San Francisco during lunchtime.

The restaurant making the burritos would have to pre-make the burritos between 7am and 10:30am and ensure that they were made available to supply depots around the city.

From 11am-1PM we would accept orders in the app. An order would be dispatched to a bike or walking courier who would walk the burrito from the supply depot to the consumer who ordered it. The goal was to make sure you had a hot lunch and could get it quickly.

When it worked, it was awesome and it helped validate the consumer demand very clearly. But we lost a lot of burritos due to spoilage and no amount of data analysis and better supply positioning could make up for it. It was also not at all economically viable to bake in a 20-30% loss rate and price the burritos high enough to grow as a business. People will pay a lot for on-demand food, but we found they were willing to wait 30 minutes (if it came straight from the restaurant) and pay a little more (if we dispatched with more courier delays), so the on-demand marketplace was born.

With the COVID-19 vaccine, right now I think it would be political suicide to accept a 30% daily loss rate on expired vaccines, even if it meant we vaccinated people twice as fast. There would need to be a higher vaccine supply available where vaccine expiry becomes as moot point as a spoiled burrito.

>With the COVID-19 vaccine, right now I think it would be political suicide to accept a 30% daily loss rate on expired vaccines, even if it meant we vaccinated people twice as fast. There would need to be a higher vaccine supply available where vaccine expiry becomes as moot point as a spoiled burrito.

Or use the Oxford vaccine:

https://www.independent.co.uk/news/health/oxford-vaccine-cov...

which can be stored at a more reasonable 2C - 8C (35.6F - 46.4F)

The Oxford vaccine is viral vector type and has more antigenic properties. mRNA vaccine..in my limited reading..seems to be a far superior tech when it comes to antigenic effects as it’s simple. So minimum short term and long term side effects

Thanks for sharing the Uber Burrito experience.

Have you heard of Mumbai’s dabbawallas? What are your thoughts about that system? https://en.m.wikipedia.org/wiki/Dabbawala

https://phys.org/news/2006-06-bombay-dabbawalas-high-tech.ht...

[..] Indeed the Dabbawala's method of lunch delivery is unique. Their origin dates back to the 1890s, a period when Bombay saw an influx of people from various communities and regions of India migrating to the city to seek livelihood. According to the Association, there were no canteens or fast-food centers then, and those who could not take a packed lunch from home since they had to leave early invariably had to go hungry.

Besides, different communities had different tastes and preferences that could only be satisfied by a home-cooked meal. Recognizing the need, a migrant from the Indian state of Maharashtra called Mahadeo started the lunch delivery service with about 100 men, and the rest is history.

For over 115 years these lunch deliverymen who were subsequently started to be called Dabbawalas have been collecting lunch packed in three or two-tier metal boxes (called dabbas) from subscribers' homes and delivering them to their workplaces.

Today the 5,000 Dabbawalas make about 200,000 lunch deliveries in the city and have become famous for their clockwork precision and efficiency. Reportedly their mistake rate is just 1 in 16 million deliveries, which caused the Forbes Global magazine to award its Six Sigma certification in 2001. According to Forbes the Dabbawalas work with 99.999999 percent accuracy.[..]

Thanks for sharing, had no idea about the dabbawalas but that's fascinating. Definitely I think the demand and supply patterns of such a system have found their equilibrium over the past 115 years. Which is probably what makes it work and makes it resilient to all the societal changes we've experienced since then.

Much harder to replicate something like that on a shorter time frame of 6 months!

supply chain is supply chain is supply chain.

you need collection from multiple nodes, aggregation, sorting and then distribution to multiple nodes.

uber model is likely flawed because there isnt enough volume to scale. without aggregation, you cant capture economies of scale. there isnt standardisation at source or end points to justify aggregation. the game is over before it starts to make $$.

my 2c.

on a related note and going back to the actual topic of discussion: this is why mobile delivery of vaccines door to door will work better than the public driving down to isolated hospital centers to be vaccinated.

at this scale...and for CA alone, it's 40 million residents...its never going to be possible to vaccinate us all. and also why africa and china and india(1.2, 1.3 and 1.4 billion people respectively) will be able to do a better job than the usa when it comes to covid. again.

You're partially right, and creating additional supply (especially with restaurants) was one of the main challenges. We tried bringing chain restaurants like McDonalds to table to start to address this. The latest version was a concept of ghost kitchens (restaurants with excess production capacity that was under utilized for in-person dining, with more flexibility on cuisine choices). Super interesting topic as well.

There is another supply issue with door-to-door vaccine delivery which is the courier distribution. Amazon Flex works because its fairly low barrier to spin up vans and delivery drivers. With vaccines you get into compliance/regulatory challenges as well as refrigeration etc. Some of these regulations would likely need to be intentionally loosened to enable a greater volume of delivery drivers and vans to hit the road.

Because most Americans have cars and are capable of traveling to a facility. The bottleneck in our vaccination pipeline is actually getting enough doses, not getting people to clinics. The same is not true in less developed countries — over there, getting people to come to a clinic is an actual bottleneck.

I don’t think the problem is with Americans driving to hospitals. How many staff do you need..how many parking spaces per hospital..how do you schedule and the exposure risk while congregating so many people.

While we are discouraging people to assemble in large numbers due to virulence, it makes no sense to invite people to ‘come and get it’.

Further: The cost of installing storage and refrigeration units for a small amount of doses is a lot more than mobile units because mobile units can service a lot more people and there will be less wastage due to spoilage.

The vaccine doesn't need the ultra cold storage at the point of use.

Vaccine vans make sense for areas without normal medical access. This is why developing nations do it: it is the easiest way to roll out medical care to people who don't normally have it.

In the US (and most of Europe...) people have plenty of access to more equipped medical facilities. My local pharmacy that I go to for the flu shot has more drugs than would even fit in a van - even assuming one does of each drug. This is typical for any developed country. So it makes sense for us to use that existing supply chains as much as possible.

Note that West Virginia - the state that has the best record as to getting vaccines into arms stated the key to their success was using the existing pharmacies in the state (not just the big national chains, all the independents). The states that are doing the worst are trying to develop some new infrastructure just for this.

> My local pharmacy that I go to for the flu shot has more drugs than would even fit in a van - even assuming one does of each drug. This is typical for any developed country.

But do they have enough staff? Enough parking spaces? We are asked to socially distance.

California has 40 million people. W.Virginia has 1.792 million population. A lot of Latinos ..esp working in Ag fields in CA(I am thinking of that sector here especially) live in close quarters and use shared transport. There are many family members in one dwelling. Many don’t have insurance and are undocumented.

Sure, there are a lot of them, and only a few vaccines. If we tried to vaccinate the whole country in a day there would be able problem, but over two months most people go to a pharmacy anyway. (Many are in some other store)

Because former POTUS Trump had no plan to deal with COVID 19, aside from "wait it out."